Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 6;105(2):pzae133.
doi: 10.1093/ptj/pzae133.

Neck or Shoulder? Establishing Consensus for Spine Screening in Patients With Shoulder Pain: An International Modified Delphi Study

Néstor Requejo-Salinas  1   2 , Rubén Fernández-Matías  3 , Angela Cadogan  4 , Rachel Chester  5 , Jean-Sébastien Roy  6   7 , Filip Struyf  8 , Marcus Bateman  9 , Simon Balster  10 , Melina Nevoeiro Haik  11 , Amee L Seitz  12 , Leanne Bisset  13 , Paula Rezende Camargo  14 , Jean-Michel Brismée  15 , Stephen May  16 , Tom Walker  17 , Craig Wassinger  18 , Ross Lenssen  10 , Jared K Powell  19 , Karen McCreesh  20   21 , Jo Gibson  22 , Paula M Ludewig  23   24 , Roy La Touche  1   25 , Enrique Lluch-Girbés  26   27
Affiliations

Neck or Shoulder? Establishing Consensus for Spine Screening in Patients With Shoulder Pain: An International Modified Delphi Study

Néstor Requejo-Salinas et al. Phys Ther. .

Abstract

Objective: There is no established consensus for screening the spine in patients with shoulder pain. The aim of this study was to explore the role of the spine in shoulder pain and generate a set of recommendations for assessing the potential involvement of the spine in patients with shoulder pain.

Methods: A modified Delphi study was conducted through use of an international shoulder physical therapist's expert panel. Three domains (clinical reasoning, history, and physical examination) were evaluated using a Likert scale, with consensus defined as Aiken Validity Index ≥0.7.

Results: Twenty-two physical therapists participated. Consensus was reached on a total of 30 items: clinical reasoning (n = 9), history (n = 13), and physical examination (n = 8). The statement that spinal and shoulder disorders can coexist, sometimes influencing each other and at other times remaining independent issues, along with the concept of radiating pain as an explanatory phenomenon for the spine contribution to shoulder pain, achieved the highest degree of consensus.

Conclusion: International physical therapists shoulder experts reached consensus on key aspects when screening the spine in people with shoulder pain, including consideration of the distal location of symptoms relative to the shoulder, the presence or previous history of neck pain, the changes in symptoms related to neck movements, and the presence of neuropathic-like symptoms. They also acknowledged the importance of assessing active cervical or cervicothoracic movements and the usefulness of the Spurling test and symptom modification techniques applied to the spine.

Impact: This consensus holds implications for both clinical practice and research. In research, applying these considerations may ensure more homogenous samples, thereby enhancing the investigation of outcomes in shoulder pain populations. In clinical practice, determining the need for spine screening and its potential impact on prognosis and management could significantly influence patient care.

Keywords: Clinical Reasoning; Delphi Study; History; Physical Examination; Shoulder Pain; Spine Screening.

PubMed Disclaimer